Pelvic Organ Prolapse & Ending the Epidemic of Unnecessary Hysterectomies

November 1, 2009
Taken from the November/December 2009 issue of the Women's Health Activist Newsletter.

Long ago, I decided I would do anything I could to keep my body intact, and sought a third opinion (a woman) who agreed with me. My research found alternatives, but they are rarely discussed in gynecologists’ offices. In fact, until recently, they were deemed not to be effective — or worse, to cause harm. More recent studies, particularly those conducted in Europe and Israel, are now finding that there are indeed safe alternatives to hysterectomies.

As I thought about my situation, I considered the possibility that three years of a minimum dose of statins could be the cause. Because it is well-known that statin use can weaken muscles, I believe it is possible that the medication may have caused my prolapse. Recently, statins have been shown to cause actual structural damage to muscles in some people. I found only one study correlating statin use with pelvic organ prolapse. Nevertheless, I stopped the statin use.

I looked for exercises first (Kegels are the most well-known) and used resources, some of which are listed at the end of this article. After six months, the third gynecologist told me the prolapse had improved by 50 percent. I still look for alternatives to continue the quest to save my uterus. Because my case is not severe, I can’t judge how this will work for everyone. But, although these alternatives take time, persistence, and patience, they are a good first step before considering the more extreme treatments.

What is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when the uterus slips out of its usual position in a woman’s body. This happens when the muscles and connective tissue that form a sling across the opening of a woman’s pelvis — and hold the bladder, uterus, bowels, and rectum in place — are weakened or injured. Lacking support, these organs press upon the vagina and can eventually protrude through the vaginal canal. The risk of pelvic organ prolapse increases with age, and with the number of vaginal births a woman has. Obesity and reduced estrogen levels are also factors in pelvic organ prolapse.

Pelvic organ prolapse can be extremely uncomfortable, can hamper physical activity, and interferes with sexual functioning. It has traditionally been treated by performing a hysterectomy to remove the woman’s uterus. In fact, the three most common reasons that hysterectomies are performed are pelvic organ prolapse, fibroid tumors, and endometriosis. (Hysterectomies are also performed to treat cancers of the uterus, ovaries, or cervix.) Among women of reproductive age (between 15 and 44), hysterectomy is the second-most frequently performed surgery. About 600,000 are performed in the U.S. every year. By age 60, one-third of all U.S. women will have had the procedure.1

Yet, many of these hysterectomies are unnecessary. As far back as 1948, there was documented evidence that too many hysterectomies were being done in the U.S. The women’s movement took this issue up in the 1960s, and hysterectomies (along with tonsillectomies) were the primary subjects of a 1978 Congressional hearing on unnecessary surgeries.2  Recent findings from over 850,000 counseling sessions conducted by the HERS Foundation estimated that almost all (98%) hysterectomies could be avoided with either conservative treatment or no treatment at all.3

Unnecessary hysterectomies are a problem because any surgery carries risks and complications for the individual. Secondly, hysterectomy involves removing the uterus and severing the ligaments that support the uterus and the entire pelvic structure. As a result, the pelvis broadens and becomes wider and the individual’s blood supply can be disrupted. Women who have had a hysterectomy may lose sensation to their vagina, clitoris, and/or nipples; experience chronic pain; or have inflammation of the nerve endings.4 Yet, too many doctors rely on hysterectomy to treat for pelvic organ prolapse, rather than first attempting to address the condition with equally effective but more benign treatments.

Surgery & Alternatives

Women suffering from pelvic organ prolapse should always attempt alternative treatments before having a hysterectomy. Behavioral therapies that can help with pelvic organ prolapse include healthy diet, weight-loss diet (for those who are overweight); exercises to strengthen pelvic muscles; devices (called pessaries) that are inserted into the vagina to hold up the bladder and/or other pelvic organs; and medication.

The best bet is to find a gynecologist who is not focused on removing the uterus as a first resort. It is wise to seek a second and/or third opinion, especially if the first doctors seen recommend any type of surgery for pelvic organ prolapse. As the U.S. Dept. of Human Services notes, “Talk to your doctor about non-surgical treatments to try first. Doing so is really important if the recommendation for a hysterectomy is for a reason other than cancer.5  ” For women who have exhausted other approaches and for whom surgery is determined to be the best option, hysterectomy may still not be the preferred route. Other surgeries can be effective, and have a less severe impact on a woman’s body.

In April, 2009, research presented at the American Urological Association’s (AUA) 104th Annual Scientific Meeting indicated that uterus-sparing surgery (e.g., not hysterectomy) is safe and effective for women wishing “to preserve the integrity of vaginal function after pelvic organ prolapsed.6 ” Some such surgeries include sacral colpopexy, a type of surgery that uses a synthetic mesh to support the vagina by suturing the mesh to the sacrum; lifting and “tucking” the ligaments; and laparoscopic uterine suspension. These results were described as helping to “dispel the myth that a hysterectomy is the only treatment for pelvic organ prolapsed.7 ” The researchers concluded: “Hysterectomy should not be the only option for women with pelvic organ prolapsed.”8

Conclusion

My experience has convinced me that it is time to speak out about unnecessary hysterectomies. I urge women who experience pelvic organ prolapse to learn about alternatives to surgery, seek second (or third!) opinions when hysterectomy is recommended, and speak openly about their experience. This common condition, experienced by up to 25% of U.S. women deserves dedicated research to figure out effective and less invasive alternatives to save the whole woman 9. Women have been let down on this issue and it is time for us to speak up for our well being.

Pam Geyer is a health care specialist and medical writer, with an MA, MBA in Health Care Administration. She can be reached at pgeyer@medcetera.com.

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Resources

References

1. National Women’s Health Information Center, US Department of Health and Human Services,Hysterectomy: Frequently Asked Questions, Rockville, MD: Office of Women’s Health. July 2006. Available online at http://www.womenshealth.gov/faq/hysterectomy.cfm

2. Healthfacts, “Unnecessary hysterectomy: the controversy that will not die”, Healthfacts, July 1993. Available online at http://findarticles.com/p/articles/mi_m0815/is_nl70_v18/ai_13218625.

3. Coffey, N, “Paying for the bailout: How unnecessary medical procedures are taxing the system,” The WIP, February 4, 2009. Available online: athttp://www.thewip.net/contributors/2009/02/paying_for_the_bailout_how_unn.html.

4. Coffey, N, HERS Foundation Newletter, Bayla Cynwyd, PA: HERS Foundation, Vol. V, Number 11. no date.

5. National Women’s Health Information Center, US Department of Health and Human Services,Hysterectomy: Frequently Asked Questions, Rockville, MD: Office of Women’s Health. July 2006. Available online at http://www.womenshealth.gov/faq/hysterectomy.cfm

6. Costantini E, Lazzeri M, Zucchi A et al., “Long-term follow-up of uterus sparing surgery for pelvic organ prolapse (POP)”. J. Urol Suppl 2009: 181(4) abstract 1355.

7. Costantini E, Lazzeri M, Zucchi A et al., “Long-term follow-up of uterus sparing surgery for pelvic organ prolapse (POP)”. J. Urol Suppl 2009: 181(4) abstract 1355.

8. Costantini E, Lazzeri M, Zucchi A et al., “Long-term follow-up of uterus sparing surgery for pelvic organ prolapse (POP)”. J. Urol Suppl 2009: 181(4) abstract 1355.

9. Nygaard I, Barber M, Burgio K, et. al., “Prevalence of symptomatic pelvic floor disorders in us women”, JAMA 2008; 300(11):1311-1316. Available online at: http://jama.ama-assn.org/cgi/content/abstract/300/11/1311.